HEALTH CARE/Joan Retsinas

Opioid Entrepreneurs Battle Government: David vs. Goliath

Intrepid Entrepreneurs versus Intrusive Government: This is a tale of modern Horatio Algers, shackled.

For today’s Mrs. Robinson, the word is “opioids.” Therein lies prosperity. Hundreds of entrepreneurs have profited, but they have had to battle government.

Step one to a fortune: Identify an unmet need – a craving. What better craving than Elysium, a pharmacologic high – or, more prosaically, a respite from pain. But the government has outlawed many of the elixirs – heroin, marijuana, opium ... and a Horatio Alger who enters those markets risks jail, maybe death (from competitors or customers). As for tobacco and alcohol – both pleasure-products – the government stringently regulates them. Besides, Big Corporations control those markets, leaving no opportunity for mom-and-pop operations.

But prescription opioids, like oxycodone, give moms-and-pops a chance. The pills work. No little pink placebo. Taken regularly, they will give sufferers a respite from pain – and will give others a delirious high. They are addictive – making them a wonderful product, market-wise. They are legal. You can purchase them in bulk from a supplier.

Second step: rent a storefront clinic, one convenient to would-be customers. A shopping mall will do. You don’t need the high-rent part of town. You don’t need to locate near a hospital, or near doctors’ offices. Find someplace cheap, accessible, with parking.

Third step: pick a name for the clinic. Nothing too obvious. “Pain Be Gone” sounds phony. Don’t explicitly tout Oxycodone – that will alert the federal Drug Enforcement Agency. Put “Health” or “Medical” in the title. Check that you are not trespassing on anybody else’s moniker.

Fourth step: choose a state with minimal regulations, one that doesn’t require a physician to own the clinic, that doesn’t require the clinic to electronically track, and transmit, sales, that doesn’t share data with other states. Most important, find a state – even one with stringent regulations on its books – that spends virtually nothing on inspections, compliance, or prosecutions.

Fifth step: find a doctor willing to write prescriptions for people he has barely met, whose medical records he has never seen, whose primary care physicians he has never consulted, whose pharmaceutical history he hasn’t probed — somebody who skipped the “Do No Harm” part of the Hippocratic Oath. You will need to pay this physician well. He or she won’t want an equity interest in your clinic. Just in case the clinic has legal problems, the physician will want “contract-employee” status. But you need only one or two physicians, licensed to practice in your state. No need for admitting privileges at any hospital, board certification, or training in pain-management.

Now open. Minimal advertising will work. Word-of-mouth will carry your message to people suffering from all sorts of maladies, people desperate for relief, people who can be hooked. And the dealers, the ones who sell these pills on the black market, will discover you too. But they, as well as you, will disguise their status as dealers.

The money will follow. Consider: a visit might cost $200. Customer-patients (the distinction blurs) will generally pay with cash. No insurance accepted. Since insurers track drug purchases, you wouldn’t want insurance reimbursement, or the headache of billing.

The Wall Street Journal recounts the success of Jeffrey Gonzalez (Timothy W. Martin, “The Pill Mill Crackdown Sets off a Rush into Georgia,” Dec. 25, 2012). He opened a clinic in Georgia. His background: he sold used cars. But entrepreneurial savvy is fungible. Demand. Supply. Price. Costs. The basics remain the basics. Mr. Gonzalez quickly made a lot of money as he revved up to meet growing demand.

Unhappily, his Southern Health Clinic closed when federal officials raided it, suspecting sales to black market dealers. Mr. Gonzalez lost to Big Government – truly unfair. Think of the tax revenues lost, the people unemployed, the rental space now empty. The Tea Party should take up Mr. Gonzalez’s cause. But more people like Mr. Gonzalez are out there, proving that the American dream still lives.

A century ago, in a more laissez-faire time, Horatio Alger didn’t fight Government. Today these Algers must wrestle with Regulations. Florida recently grew alarmed at the increase in addicts, in drug-deaths, in crime. Hospitals tabulated the babies born to mothers addicted to oxycontin. (Hospitals have yet to devise a treatment protocol: these babies writhe in painful spasms as they languish in ICUs at Medicaid expense). So Florida tightened its standards.

The good news for opioid entrepreneurs: our 50 states comprise a hodgepodge of regulations. When Florida tightened its standards, clinics moved to Georgia. Two years ago the “Peach State” had 10 opioid clinics; today the “pill state” has 125. Supply follows demand, when government steps back. Especially for drugs.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.